Kristie Marie Urdahl, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

084014 Issued in NY

Practice address

201 Sunrise Hwy W
Patchogue, NY 11772-1868

Phone

(631) 289-2200

Fax

(631) 286-6955

NPI assigned

Oct 26, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Kristie Marie Rugolo Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastern Suffolk Boces

  • Public Health or Welfare Agency
  • Patchogue, NY
  • NPI 1073890091
  NPD (past)
• Esboces

  • Public Health or Welfare Agency
  • Patchogue, NY
  • NPI 1093092025
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1922725308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 MARC ST",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117794314",
            "telephone_number": "631-289-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SUNRISE HWY W",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721868",
            "telephone_number": "631-289-2200",
            "fax_number": "631-286-6955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URDAHL",
        "first_name": "KRISTIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-26",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "084014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSE NUMBER",
            "identifier": "084014",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kurdahl@esboces.org",
            "affiliation": "N",
            "endpointDescription": "kurdahl@esboces.org",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email adress",
            "address_1": "201 Sunrise Hwy W",
            "city": "Patchogue",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117721868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTIE",
            "last_name": "RUGOLO",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joanna Tutrone, P.A.
• Asif Uddin, MD
• Ikemesit Udo-Bellner
• Eleanore A Uneberg, ANP
• Stephan E Ungar, PT
• Lisa Valle
• Laura Anne Van Schaick-Harman, PSYD
• Stephanie Lauren Vanschaick, DPT
• Raja Gunturi Varma, MD
• Melissa A. Varveris, SLP

• Clinical Social Worker in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.